Adaptation Model of Nursing - Overview of The Theory

Overview of The Theory

This model comprises the four domain concepts of person, health, environment, and nursing; it also involves a six-step nursing process. Andrews & Roy (1991) state that the person can be a representation of an individual or a group of individuals. Roy's model sees the person as "a biopsychosocial being in constant interaction with a changing environment" (Rambo, 1984). The person is an open, adaptive system who uses coping skills to deal with stressors. Roy sees the environment as "all conditions, circumstances and influences that surround and affect the development and behaviour of the person" (Andrews & Roy, 1991). Roy describes stressors as stimuli and uses the term residual stimuli to describe those stressors whose influence on the person is not clear (Andrews & Roy). Originally, Roy wrote that health and illness are on a continuum with many different states or degrees possible (Rambo, 1984). More recently, she states that health is the process of being and becoming an integrated and whole person (Andrews & Roy). Roy's goal for nursing is "the promotion of adaptation in each of the four modes, thereby contributing to the person's health, quality of life and dying with dignity" (Andrews & Roy). These four modes are physiological, self-concept, role function and interdependence.

Roy employs a six-step nursing process: assessment of behaviour; assessment of stimuli; nursing diagnosis; goal setting; intervention and evaluation. In the first step, the person's behaviour in each of the four modes is observed. This behaviour is compared with norms and is deemed either adaptive or ineffective. The second step is concerned with factors that influence behaviour. Stimuli are classified as focal, contextual or residual (Rambo, 1984). The nursing diagnosis is the statement of the ineffective behaviours along with the identification of the probable cause. In the fourth step, goal setting is the focus. Goals need to be realistic and attainable and are set in collaboration with the person (Andrews & Roy, 1991). Intervention occurs as the fifth step, and this is when the stimuli are manipulated. It is also called the 'doing phase' (Rambo). In the final stage, evaluation takes place. The degree of change as evidenced by change in behaviour, is determined. Ineffective behaviours would be reassessed, and the interventions would be revised (Andrews & Roy).

The model had its inception in 1964 when Roy was a graduate student. She was challenged by nursing faculty member Dorothy E. Johnson to develop a conceptual model for nursing practice. Roy’s model drew heavily on the work of Harry Helson, a physiologic psychologist (Roy, 1980). The Roy adaptation model is generally considered a "systems" model; however, it also includes elements of an "interactional" model. The model was developed specifically for the individual client, but it can be adapted to families and to communities (Roy, 1983). Roy states (Clements and Roberts, 1983) that "just as the person as an adaptive system has input, output. and internal processes so too the family can be described from this perspective."

Basic to Roy’s model are three concepts: the human being, adaptation, and nursing. The human being is viewed as a biopsychosocial being who is continually interacting with the environment. The human being’s goal through this interaction is adaptation. According to Roy and Roberts (1981, p. 43), ‘The person has two major internal processing subsystems, the regulator and the cognator." These subsystems are the mechanisms used by human beings to cope with stimuli from the internal and external environment. The regulator mechanism works primarily through the autonomic nervous system and includes endocrine, neural, and perception pathways. This mechanism prepares the individual for coping with environmental stimuli. The cognator mechanism includes emotions, perceptual/information processing, learning, and judgment. The process of perception bridges the two mechanisms (Roy and Roberts, 1981).